|
ABSORBATACK FIXATION DEVICE 15
|
Facility
|
IP
|
$840.00
|
|
| Hospital Charge Code |
2650565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.78 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$823.20
|
| Rate for Payer: Aetna of WY Medicare |
$537.60
|
| Rate for Payer: Altius Commercial |
$806.40
|
| Rate for Payer: Beech Street Commercial |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$814.80
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$814.80
|
| Rate for Payer: Cigna of WY Commercial |
$823.20
|
| Rate for Payer: Entrust Commercial |
$798.00
|
| Rate for Payer: First Choice Health Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$798.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$512.40
|
| Rate for Payer: HealthUtah PPO |
$840.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$814.80
|
| Rate for Payer: Multiplan Medicare/VA |
$486.78
|
| Rate for Payer: One Health Plan of WY PPO |
$823.20
|
| Rate for Payer: PacificSource Commercial |
$756.00
|
| Rate for Payer: PHCS PPO |
$823.20
|
| Rate for Payer: Three Rivers PPO |
$630.00
|
| Rate for Payer: TriWest Veterans Administration |
$512.40
|
| Rate for Payer: United Healthcare Commercial |
$802.20
|
| Rate for Payer: United Healthcare Medicare |
$512.40
|
| Rate for Payer: WINHealth Partners Commercial |
$798.00
|
| Rate for Payer: Wise Provider Network Commercial |
$798.00
|
|
|
ACAPELLA GREEN HIGH FLO
|
Facility
|
IP
|
$134.92
|
|
| Hospital Charge Code |
2100039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.22
|
| Rate for Payer: Aetna of WY Medicare |
$86.35
|
| Rate for Payer: Altius Commercial |
$129.52
|
| Rate for Payer: Beech Street Commercial |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$94.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.87
|
| Rate for Payer: Cigna of WY Commercial |
$132.22
|
| Rate for Payer: Entrust Commercial |
$128.17
|
| Rate for Payer: First Choice Health Commercial |
$128.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$82.30
|
| Rate for Payer: HealthUtah PPO |
$134.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.87
|
| Rate for Payer: Multiplan Medicare/VA |
$78.19
|
| Rate for Payer: One Health Plan of WY PPO |
$132.22
|
| Rate for Payer: PacificSource Commercial |
$121.43
|
| Rate for Payer: PHCS PPO |
$132.22
|
| Rate for Payer: Three Rivers PPO |
$101.19
|
| Rate for Payer: TriWest Veterans Administration |
$82.30
|
| Rate for Payer: United Healthcare Commercial |
$128.85
|
| Rate for Payer: United Healthcare Medicare |
$82.30
|
| Rate for Payer: WINHealth Partners Commercial |
$128.17
|
| Rate for Payer: Wise Provider Network Commercial |
$128.17
|
|
|
ACAPELLA GREEN HIGH FLO
|
Facility
|
OP
|
$134.92
|
|
| Hospital Charge Code |
2100039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$132.22
|
| Rate for Payer: Aetna of WY Medicare |
$89.05
|
| Rate for Payer: Altius Commercial |
$129.52
|
| Rate for Payer: Beech Street Commercial |
$132.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$94.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$130.87
|
| Rate for Payer: Cigna of WY Commercial |
$132.22
|
| Rate for Payer: Entrust Commercial |
$128.17
|
| Rate for Payer: First Choice Health Commercial |
$128.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$128.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.90
|
| Rate for Payer: HealthUtah PPO |
$134.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$130.87
|
| Rate for Payer: Multiplan Medicare/VA |
$73.06
|
| Rate for Payer: One Health Plan of WY PPO |
$132.22
|
| Rate for Payer: PacificSource Commercial |
$121.43
|
| Rate for Payer: PHCS PPO |
$132.22
|
| Rate for Payer: Three Rivers PPO |
$101.19
|
| Rate for Payer: TriWest Veterans Administration |
$76.90
|
| Rate for Payer: United Healthcare Commercial |
$128.85
|
| Rate for Payer: United Healthcare Medicare |
$76.90
|
| Rate for Payer: WINHealth Partners Commercial |
$132.22
|
| Rate for Payer: Wise Provider Network Commercial |
$128.17
|
|
|
ACCLARENT BALLOON SYS 10X40
|
Facility
|
IP
|
$2,432.50
|
|
| Hospital Charge Code |
3002265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,409.63 |
| Max. Negotiated Rate |
$2,432.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,556.80
|
| Rate for Payer: Altius Commercial |
$2,335.20
|
| Rate for Payer: Beech Street Commercial |
$2,383.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,359.52
|
| Rate for Payer: Cash Price |
$1,702.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.85
|
| Rate for Payer: Entrust Commercial |
$2,310.88
|
| Rate for Payer: First Choice Health Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,483.82
|
| Rate for Payer: HealthUtah PPO |
$2,432.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,409.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.85
|
| Rate for Payer: PacificSource Commercial |
$2,189.25
|
| Rate for Payer: PHCS PPO |
$2,383.85
|
| Rate for Payer: Three Rivers PPO |
$1,824.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,483.82
|
| Rate for Payer: United Healthcare Commercial |
$2,323.04
|
| Rate for Payer: United Healthcare Medicare |
$1,483.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,310.88
|
| Rate for Payer: Wise Provider Network Commercial |
$2,310.88
|
|
|
ACCLARENT BALLOON SYS 10X40
|
Facility
|
OP
|
$2,432.50
|
|
| Hospital Charge Code |
3002265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.20 |
| Max. Negotiated Rate |
$2,432.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,605.45
|
| Rate for Payer: Altius Commercial |
$2,335.20
|
| Rate for Payer: Beech Street Commercial |
$2,383.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,359.52
|
| Rate for Payer: Cash Price |
$1,702.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.85
|
| Rate for Payer: Entrust Commercial |
$2,310.88
|
| Rate for Payer: First Choice Health Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,386.52
|
| Rate for Payer: HealthUtah PPO |
$2,432.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,317.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.85
|
| Rate for Payer: PacificSource Commercial |
$2,189.25
|
| Rate for Payer: PHCS PPO |
$2,383.85
|
| Rate for Payer: Three Rivers PPO |
$1,824.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,386.52
|
| Rate for Payer: United Healthcare Commercial |
$2,323.04
|
| Rate for Payer: United Healthcare Medicare |
$1,386.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,383.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2,310.88
|
|
|
ACCLARENT BALLOON SYS 12X40
|
Facility
|
IP
|
$2,432.50
|
|
| Hospital Charge Code |
3002266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,409.63 |
| Max. Negotiated Rate |
$2,432.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,556.80
|
| Rate for Payer: Altius Commercial |
$2,335.20
|
| Rate for Payer: Beech Street Commercial |
$2,383.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,359.52
|
| Rate for Payer: Cash Price |
$1,702.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.85
|
| Rate for Payer: Entrust Commercial |
$2,310.88
|
| Rate for Payer: First Choice Health Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,483.82
|
| Rate for Payer: HealthUtah PPO |
$2,432.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,409.63
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.85
|
| Rate for Payer: PacificSource Commercial |
$2,189.25
|
| Rate for Payer: PHCS PPO |
$2,383.85
|
| Rate for Payer: Three Rivers PPO |
$1,824.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,483.82
|
| Rate for Payer: United Healthcare Commercial |
$2,323.04
|
| Rate for Payer: United Healthcare Medicare |
$1,483.82
|
| Rate for Payer: WINHealth Partners Commercial |
$2,310.88
|
| Rate for Payer: Wise Provider Network Commercial |
$2,310.88
|
|
|
ACCLARENT BALLOON SYS 12X40
|
Facility
|
OP
|
$2,432.50
|
|
| Hospital Charge Code |
3002266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,317.20 |
| Max. Negotiated Rate |
$2,432.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,383.85
|
| Rate for Payer: Aetna of WY Medicare |
$1,605.45
|
| Rate for Payer: Altius Commercial |
$2,335.20
|
| Rate for Payer: Beech Street Commercial |
$2,383.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2,359.52
|
| Rate for Payer: Cash Price |
$1,702.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,359.52
|
| Rate for Payer: Cigna of WY Commercial |
$2,383.85
|
| Rate for Payer: Entrust Commercial |
$2,310.88
|
| Rate for Payer: First Choice Health Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,310.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,386.52
|
| Rate for Payer: HealthUtah PPO |
$2,432.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,359.52
|
| Rate for Payer: Multiplan Medicare/VA |
$1,317.20
|
| Rate for Payer: One Health Plan of WY PPO |
$2,383.85
|
| Rate for Payer: PacificSource Commercial |
$2,189.25
|
| Rate for Payer: PHCS PPO |
$2,383.85
|
| Rate for Payer: Three Rivers PPO |
$1,824.38
|
| Rate for Payer: TriWest Veterans Administration |
$1,386.52
|
| Rate for Payer: United Healthcare Commercial |
$2,323.04
|
| Rate for Payer: United Healthcare Medicare |
$1,386.52
|
| Rate for Payer: WINHealth Partners Commercial |
$2,383.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2,310.88
|
|
|
ACCLARENT SE INFLATION DEVICE
|
Facility
|
OP
|
$260.92
|
|
| Hospital Charge Code |
3002182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Aetna of WY Medicare |
$172.21
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.09
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.72
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$141.29
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$148.72
|
| Rate for Payer: United Healthcare Commercial |
$249.18
|
| Rate for Payer: United Healthcare Medicare |
$148.72
|
| Rate for Payer: WINHealth Partners Commercial |
$255.70
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACCLARENT SE INFLATION DEVICE
|
Facility
|
IP
|
$260.92
|
|
| Hospital Charge Code |
3002182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: United Healthcare Commercial |
$249.18
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Aetna of WY Medicare |
$166.99
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.09
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.16
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$151.20
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$159.16
|
| Rate for Payer: United Healthcare Medicare |
$159.16
|
| Rate for Payer: WINHealth Partners Commercial |
$247.87
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACCLARENT SINUS BALL CATH 6X24
|
Facility
|
OP
|
$6,825.00
|
|
| Hospital Charge Code |
3002183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,695.74 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,504.50
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,620.25
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,890.25
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,695.74
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,890.25
|
| Rate for Payer: United Healthcare Commercial |
$6,517.88
|
| Rate for Payer: United Healthcare Medicare |
$3,890.25
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
ACCLARENT SINUS BALL CATH 6X24
|
Facility
|
IP
|
$6,825.00
|
|
| Hospital Charge Code |
3002183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,955.09 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,368.00
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,620.25
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,163.25
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,955.09
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,163.25
|
| Rate for Payer: United Healthcare Commercial |
$6,517.88
|
| Rate for Payer: United Healthcare Medicare |
$4,163.25
|
| Rate for Payer: WINHealth Partners Commercial |
$6,483.75
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
ACCLARENT SINUS BALLOON DEVICE
|
Facility
|
IP
|
$260.92
|
|
| Hospital Charge Code |
3002267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Aetna of WY Medicare |
$166.99
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.09
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$159.16
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$151.20
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$159.16
|
| Rate for Payer: United Healthcare Commercial |
$249.18
|
| Rate for Payer: United Healthcare Medicare |
$159.16
|
| Rate for Payer: WINHealth Partners Commercial |
$247.87
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACCLARENT SINUS BALLOON DEVICE
|
Facility
|
OP
|
$260.92
|
|
| Hospital Charge Code |
3002267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$260.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$255.70
|
| Rate for Payer: Aetna of WY Medicare |
$172.21
|
| Rate for Payer: Altius Commercial |
$250.48
|
| Rate for Payer: Beech Street Commercial |
$255.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$253.09
|
| Rate for Payer: Cash Price |
$182.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$253.09
|
| Rate for Payer: Cigna of WY Commercial |
$255.70
|
| Rate for Payer: Entrust Commercial |
$247.87
|
| Rate for Payer: First Choice Health Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$247.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.72
|
| Rate for Payer: HealthUtah PPO |
$260.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$253.09
|
| Rate for Payer: Multiplan Medicare/VA |
$141.29
|
| Rate for Payer: One Health Plan of WY PPO |
$255.70
|
| Rate for Payer: PacificSource Commercial |
$234.83
|
| Rate for Payer: PHCS PPO |
$255.70
|
| Rate for Payer: Three Rivers PPO |
$195.69
|
| Rate for Payer: TriWest Veterans Administration |
$148.72
|
| Rate for Payer: United Healthcare Commercial |
$249.18
|
| Rate for Payer: United Healthcare Medicare |
$148.72
|
| Rate for Payer: WINHealth Partners Commercial |
$255.70
|
| Rate for Payer: Wise Provider Network Commercial |
$247.87
|
|
|
ACCLARENT SPINPLUS 6X16MM
|
Facility
|
IP
|
$6,825.00
|
|
| Hospital Charge Code |
3002239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,955.09 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,368.00
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,620.25
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4,163.25
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,955.09
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$4,163.25
|
| Rate for Payer: United Healthcare Commercial |
$6,517.88
|
| Rate for Payer: United Healthcare Medicare |
$4,163.25
|
| Rate for Payer: WINHealth Partners Commercial |
$6,483.75
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
ACCLARENT SPINPLUS 6X16MM
|
Facility
|
OP
|
$6,825.00
|
|
| Hospital Charge Code |
3002239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,695.74 |
| Max. Negotiated Rate |
$6,825.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,688.50
|
| Rate for Payer: Aetna of WY Medicare |
$4,504.50
|
| Rate for Payer: Altius Commercial |
$6,552.00
|
| Rate for Payer: Beech Street Commercial |
$6,688.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6,620.25
|
| Rate for Payer: Cash Price |
$4,777.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,620.25
|
| Rate for Payer: Cigna of WY Commercial |
$6,688.50
|
| Rate for Payer: Entrust Commercial |
$6,483.75
|
| Rate for Payer: First Choice Health Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,483.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3,890.25
|
| Rate for Payer: HealthUtah PPO |
$6,825.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,620.25
|
| Rate for Payer: Multiplan Medicare/VA |
$3,695.74
|
| Rate for Payer: One Health Plan of WY PPO |
$6,688.50
|
| Rate for Payer: PacificSource Commercial |
$6,142.50
|
| Rate for Payer: PHCS PPO |
$6,688.50
|
| Rate for Payer: Three Rivers PPO |
$5,118.75
|
| Rate for Payer: TriWest Veterans Administration |
$3,890.25
|
| Rate for Payer: United Healthcare Commercial |
$6,517.88
|
| Rate for Payer: United Healthcare Medicare |
$3,890.25
|
| Rate for Payer: WINHealth Partners Commercial |
$6,688.50
|
| Rate for Payer: Wise Provider Network Commercial |
$6,483.75
|
|
|
ACE ELASTIC BANDAGE 2"
|
Facility
|
IP
|
$0.89
|
|
| Hospital Charge Code |
2000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.87
|
| Rate for Payer: Aetna of WY Medicare |
$0.57
|
| Rate for Payer: Altius Commercial |
$0.85
|
| Rate for Payer: Beech Street Commercial |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.86
|
| Rate for Payer: Cigna of WY Commercial |
$0.87
|
| Rate for Payer: Entrust Commercial |
$0.85
|
| Rate for Payer: First Choice Health Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.54
|
| Rate for Payer: HealthUtah PPO |
$0.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.86
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$0.87
|
| Rate for Payer: PacificSource Commercial |
$0.80
|
| Rate for Payer: PHCS PPO |
$0.87
|
| Rate for Payer: Three Rivers PPO |
$0.67
|
| Rate for Payer: TriWest Veterans Administration |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
| Rate for Payer: WINHealth Partners Commercial |
$0.85
|
| Rate for Payer: Wise Provider Network Commercial |
$0.85
|
|
|
ACE ELASTIC BANDAGE 2"
|
Facility
|
OP
|
$0.89
|
|
| Hospital Charge Code |
2000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.87
|
| Rate for Payer: Aetna of WY Medicare |
$0.59
|
| Rate for Payer: Altius Commercial |
$0.85
|
| Rate for Payer: Beech Street Commercial |
$0.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.86
|
| Rate for Payer: Cigna of WY Commercial |
$0.87
|
| Rate for Payer: Entrust Commercial |
$0.85
|
| Rate for Payer: First Choice Health Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.51
|
| Rate for Payer: HealthUtah PPO |
$0.89
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.86
|
| Rate for Payer: Multiplan Medicare/VA |
$0.48
|
| Rate for Payer: One Health Plan of WY PPO |
$0.87
|
| Rate for Payer: PacificSource Commercial |
$0.80
|
| Rate for Payer: PHCS PPO |
$0.87
|
| Rate for Payer: Three Rivers PPO |
$0.67
|
| Rate for Payer: TriWest Veterans Administration |
$0.51
|
| Rate for Payer: United Healthcare Commercial |
$0.85
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
| Rate for Payer: WINHealth Partners Commercial |
$0.87
|
| Rate for Payer: Wise Provider Network Commercial |
$0.85
|
|
|
ACELL DRESSING 3X3.5CM
|
Facility
|
IP
|
$207.38
|
|
| Hospital Charge Code |
2000066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.18 |
| Max. Negotiated Rate |
$207.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.23
|
| Rate for Payer: Aetna of WY Medicare |
$132.72
|
| Rate for Payer: Altius Commercial |
$199.08
|
| Rate for Payer: Beech Street Commercial |
$203.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.16
|
| Rate for Payer: Cash Price |
$145.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.16
|
| Rate for Payer: Cigna of WY Commercial |
$203.23
|
| Rate for Payer: Entrust Commercial |
$197.01
|
| Rate for Payer: First Choice Health Commercial |
$197.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.50
|
| Rate for Payer: HealthUtah PPO |
$207.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.16
|
| Rate for Payer: Multiplan Medicare/VA |
$120.18
|
| Rate for Payer: One Health Plan of WY PPO |
$203.23
|
| Rate for Payer: PacificSource Commercial |
$186.64
|
| Rate for Payer: PHCS PPO |
$203.23
|
| Rate for Payer: Three Rivers PPO |
$155.54
|
| Rate for Payer: TriWest Veterans Administration |
$126.50
|
| Rate for Payer: United Healthcare Commercial |
$198.05
|
| Rate for Payer: United Healthcare Medicare |
$126.50
|
| Rate for Payer: WINHealth Partners Commercial |
$197.01
|
| Rate for Payer: Wise Provider Network Commercial |
$197.01
|
|
|
ACELL DRESSING 3X3.5CM
|
Facility
|
OP
|
$207.38
|
|
| Hospital Charge Code |
2000066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.30 |
| Max. Negotiated Rate |
$207.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$203.23
|
| Rate for Payer: Aetna of WY Medicare |
$136.87
|
| Rate for Payer: Altius Commercial |
$199.08
|
| Rate for Payer: Beech Street Commercial |
$203.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$201.16
|
| Rate for Payer: Cash Price |
$145.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$201.16
|
| Rate for Payer: Cigna of WY Commercial |
$203.23
|
| Rate for Payer: Entrust Commercial |
$197.01
|
| Rate for Payer: First Choice Health Commercial |
$197.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$197.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.21
|
| Rate for Payer: HealthUtah PPO |
$207.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$201.16
|
| Rate for Payer: Multiplan Medicare/VA |
$112.30
|
| Rate for Payer: One Health Plan of WY PPO |
$203.23
|
| Rate for Payer: PacificSource Commercial |
$186.64
|
| Rate for Payer: PHCS PPO |
$203.23
|
| Rate for Payer: Three Rivers PPO |
$155.54
|
| Rate for Payer: TriWest Veterans Administration |
$118.21
|
| Rate for Payer: United Healthcare Commercial |
$198.05
|
| Rate for Payer: United Healthcare Medicare |
$118.21
|
| Rate for Payer: WINHealth Partners Commercial |
$203.23
|
| Rate for Payer: Wise Provider Network Commercial |
$197.01
|
|
|
ACELL DRESSING 7X10CM
|
Facility
|
IP
|
$884.80
|
|
| Hospital Charge Code |
2000073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$512.74 |
| Max. Negotiated Rate |
$884.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$867.10
|
| Rate for Payer: Aetna of WY Medicare |
$566.27
|
| Rate for Payer: Altius Commercial |
$849.41
|
| Rate for Payer: Beech Street Commercial |
$867.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$858.26
|
| Rate for Payer: Cash Price |
$619.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$858.26
|
| Rate for Payer: Cigna of WY Commercial |
$867.10
|
| Rate for Payer: Entrust Commercial |
$840.56
|
| Rate for Payer: First Choice Health Commercial |
$840.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$840.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$539.73
|
| Rate for Payer: HealthUtah PPO |
$884.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$858.26
|
| Rate for Payer: Multiplan Medicare/VA |
$512.74
|
| Rate for Payer: One Health Plan of WY PPO |
$867.10
|
| Rate for Payer: PacificSource Commercial |
$796.32
|
| Rate for Payer: PHCS PPO |
$867.10
|
| Rate for Payer: Three Rivers PPO |
$663.60
|
| Rate for Payer: TriWest Veterans Administration |
$539.73
|
| Rate for Payer: United Healthcare Commercial |
$844.98
|
| Rate for Payer: United Healthcare Medicare |
$539.73
|
| Rate for Payer: WINHealth Partners Commercial |
$840.56
|
| Rate for Payer: Wise Provider Network Commercial |
$840.56
|
|
|
ACELL DRESSING 7X10CM
|
Facility
|
OP
|
$884.80
|
|
| Hospital Charge Code |
2000073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.12 |
| Max. Negotiated Rate |
$884.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$867.10
|
| Rate for Payer: Aetna of WY Medicare |
$583.97
|
| Rate for Payer: Altius Commercial |
$849.41
|
| Rate for Payer: Beech Street Commercial |
$867.10
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$858.26
|
| Rate for Payer: Cash Price |
$619.36
|
| Rate for Payer: ChoiceCare Network Commercial |
$858.26
|
| Rate for Payer: Cigna of WY Commercial |
$867.10
|
| Rate for Payer: Entrust Commercial |
$840.56
|
| Rate for Payer: First Choice Health Commercial |
$840.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$840.56
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$504.34
|
| Rate for Payer: HealthUtah PPO |
$884.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$858.26
|
| Rate for Payer: Multiplan Medicare/VA |
$479.12
|
| Rate for Payer: One Health Plan of WY PPO |
$867.10
|
| Rate for Payer: PacificSource Commercial |
$796.32
|
| Rate for Payer: PHCS PPO |
$867.10
|
| Rate for Payer: Three Rivers PPO |
$663.60
|
| Rate for Payer: TriWest Veterans Administration |
$504.34
|
| Rate for Payer: United Healthcare Commercial |
$844.98
|
| Rate for Payer: United Healthcare Medicare |
$504.34
|
| Rate for Payer: WINHealth Partners Commercial |
$867.10
|
| Rate for Payer: Wise Provider Network Commercial |
$840.56
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
HCPCS J0136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.01
|
| Rate for Payer: Aetna of WY Medicare |
$9.80
|
| Rate for Payer: Altius Commercial |
$14.71
|
| Rate for Payer: Beech Street Commercial |
$15.01
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.86
|
| Rate for Payer: Cash Price |
$10.73
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.86
|
| Rate for Payer: Cigna of WY Commercial |
$15.01
|
| Rate for Payer: Entrust Commercial |
$14.55
|
| Rate for Payer: First Choice Health Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.35
|
| Rate for Payer: HealthUtah PPO |
$15.32
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.88
|
| Rate for Payer: One Health Plan of WY PPO |
$15.01
|
| Rate for Payer: PacificSource Commercial |
$13.79
|
| Rate for Payer: PHCS PPO |
$15.01
|
| Rate for Payer: Three Rivers PPO |
$11.49
|
| Rate for Payer: TriWest Veterans Administration |
$9.35
|
| Rate for Payer: United Healthcare Commercial |
$14.63
|
| Rate for Payer: United Healthcare Medicare |
$9.35
|
| Rate for Payer: WINHealth Partners Commercial |
$14.55
|
| Rate for Payer: Wise Provider Network Commercial |
$14.55
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
HCPCS J0131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$9.84
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
OP
|
$15.38
|
|
|
Service Code
|
HCPCS J0131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$10.15
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.77
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.33
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$8.77
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$8.77
|
| Rate for Payer: WINHealth Partners Commercial |
$15.07
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION [91361]
|
Facility
|
IP
|
$15.38
|
|
|
Service Code
|
HCPCS J0134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.07
|
| Rate for Payer: Aetna of WY Medicare |
$9.84
|
| Rate for Payer: Altius Commercial |
$14.76
|
| Rate for Payer: Beech Street Commercial |
$15.07
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$14.92
|
| Rate for Payer: Cigna of WY Commercial |
$15.07
|
| Rate for Payer: Entrust Commercial |
$14.61
|
| Rate for Payer: First Choice Health Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.38
|
| Rate for Payer: HealthUtah PPO |
$15.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$14.92
|
| Rate for Payer: Multiplan Medicare/VA |
$8.91
|
| Rate for Payer: One Health Plan of WY PPO |
$15.07
|
| Rate for Payer: PacificSource Commercial |
$13.84
|
| Rate for Payer: PHCS PPO |
$15.07
|
| Rate for Payer: Three Rivers PPO |
$11.54
|
| Rate for Payer: TriWest Veterans Administration |
$9.38
|
| Rate for Payer: United Healthcare Commercial |
$14.69
|
| Rate for Payer: United Healthcare Medicare |
$9.38
|
| Rate for Payer: WINHealth Partners Commercial |
$14.61
|
| Rate for Payer: Wise Provider Network Commercial |
$14.61
|
|
